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At least 595 records · Page 33Linked to original sources
PubMed2003

Effects of communicating individual risks in screening programmes: Cochrane systematic review.

OBJECTIVE: To assess the effects of different types of individualised risk communication for patients who are deciding whether to participate in screening. DESIGN: Systematic review. DATA SOURCES: Specialist register of the Cochrane consumers and communication review group, scientific databases, and a manual follow up of references. SELECTION OF STUDIES: Studies were randomised controlled trials addressing decisions by patients whether or not to undergo screening and incorporating an intervention with an element of "individualised" risk communication-based on the individual's own risk factors for a condition (such as age or family history). OUTCOME MEASURES: The principal outcome was uptake of screening tests; further cognitive and affective measures were also assessed to gauge informed decision making. RESULTS: 13 studies were included, 10 of which addressed mammography programmes. Individualised risk communication was associated with an increased uptake of screening tests (odds ratio 1.5, 95% confidence interval 1.11 to 2.03). Few cognitive or affective outcomes were reported consistently, so it was not possible to conclude whether this increase in the uptake of tests was related to informed decision making by patients. CONCLUSIONS: Individualised risk estimates may be effective for purposes of population health, but their effects on increasing uptake of screening programmes may not be interpretable as evidence of informed decision making by patients. Greater attention is required to ways of developing interventions for screening programmes that can achieve this.

Communication↗
PubMed2005

Does psychological characteristic influence physicians' communication styles? Impact of physicians' locus of control on interviews with a cancer patient and a relative.

CONTEXT: Physicians' psychological characteristics may influence their communication styles and may thus interfere with patient-centred communication. OBJECTIVE: Our aim was to test the hypothesis that, in interviews with a cancer patient and a relative, physicians with an "external" locus of control (LOC; who believe that life outcomes are controlled by external forces such as luck, fate or others) have a communication style different from that of physicians with an "internal" LOC (who believe that life outcomes are controlled by their own characteristics or actions). DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: Eighty-one voluntary physicians practising in the field of oncology were recorded while performing an actual and a simulated interview with a cancer patient and a relative. MAIN OUTCOME MEASURES: Physicians' communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. The communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Student's t test. RESULTS: In actual interviews, physicians with an "external" LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an "internal" LOC. In simulated interviews, physicians with an "external" LOC used less utterances that give premature information (P=0.031) and used more utterances with a supportive function, such as empathy and reassurance (P=0.029), than physicians with an "internal" LOC. CONCLUSION: These results provide evidence that physicians' LOC can influence their communication styles. Physicians' awareness of this influence constitutes a step towards a tailoring of their communication skills to every patient's and relative's concerns and needs and thus towards a patient-centred communication.

Adult↗
PubMedDate not supplied

Efficacy of pneumococcal vaccination in adults. A meta-analysis of randomized controlled trials.

BACKGROUND: Because of the prevalence of pneumococcal pneumonia, the substantial morbidity and mortality associated with many pneumococcal infections, and an increase in the incidence of antibiotic resistance among pneumococcal isolates, considerable efforts for disease prevention have been made using a polyvalent polysaccharide pneumococcal vaccine. Despite numerous clinical trials of the vaccine, its efficacy in the prevention of pneumococcal infections and other clinically relevant medical outcomes in adults remains uncertain. METHODS: To assess quantitatively the efficacy of pneumococcal vaccination, a MEDLINE literature search, manual reviews of article bibliographies, and communications with pneumococcal vaccine investigators were used to identify randomized controlled trials of the pneumococcal vaccine. Independent review of 594 articles revealed nine randomized trials with 12 vaccine and control study groups that evaluated clinically relevant outcomes in adults. To estimate a summary effect size for all outcomes, Mantel-Haenszel odds ratios (ORs) and Dersimonian and Laird rate differences (RDs) and their associated 95% confidence intervals (CIs) were computed. RESULTS: Summary ORs demonstrated a statistically significant protective effect of the vaccine for four pneumococcal infection-related outcomes: definitive pneumococcal pneumonia (OR = 0.34; 95% CI = 0.24 to 0.48), definitive pneumococcal pneumonia for vaccine-containing pneumococcal antigen types only (vaccine types only) (OR = 0.17; 95% CI = 0.09 to 0.33), presumptive pneumococcal pneumonia (OR = 0.47; 95% CI = 0.35 to 0.63), and presumptive pneumococcal pneumonia (vaccine types only) (OR = 0.39; 95% CI = 0.26 to 0.59). The summary RDs, which account for heterogeneity among studies, confirmed a statistically significant protective effect for two of these same outcomes: definitive pneumococcal pneumonia (RD = 4/1000; 95% CI = 0/1000 to 7/1000) and definitive pneumococcal pneumonia (vaccine types only) (RD = 8/1000; 95% CI = 1/1000 to 16/1000). Summary ORs and RDs failed to demonstrate a protective effect for pneumonia (all causes), bronchitis, and mortality (all causes) or mortality due to pneumonia or pneumococcal infection. Subgroup analyses showed that for all four pneumococcal infection-related outcomes, vaccine efficacy differed for high- and low-risk subjects, demonstrating efficacy for low-risk subjects and lack of efficacy for high-risk subjects. CONCLUSIONS: Pneumococcal vaccination appears efficacious in reducing bacteremic pneumococcal pneumonia in low-risk adults. However, evidence from randomized controlled trials fails to demonstrate vaccine efficacy for pneumococcal infection-related or other medical outcomes in the heterogeneous group of subjects currently labeled as high risk.

Adult↗
PubMed1982

Oralism and the deaf child's brain: a reply to Dr. Conrad.

One of the most contentious and important issues in the education of deaf children concerns the nature of the medium that should be used. The argument is whether the language of the hearing society should be used (Oralism) or a visual manual language together with speech (Total Communication or bilingualism). Recently Conrad [6,7] has claimed that the exclusive use of Oral methods fails to provide the deaf child's brain with sufficient linguistic information at an early enough age and so runs the risk of obstructing neurological growth so that functional atrophy may occur. In this situation Conrad argues 'we should not ignore the possibility that the "functional atrophy" ...may come to involve structural atrophy as well.' He concludes that Oral schools "virtually are cognitively destroying deaf children." Conrad's case rests on his interpretation of 3 kinds of circumstantial evidence. These are animal studies of auditory deprivation, hemispheric lateralization studies of deaf and hearing subjects, and finally his own data. In the present paper each of these 3 kinds of evidence is reviewed and alternative interpretations are advanced against Conrad's hypothesis of functional atrophy. It is argued that the case that Oralism is responsible for brain atrophy is not proven. It is concluded that the main problem facing deaf children and their teachers is deafness itself, and not any particular educational philosophy and group of methods such as Oralism.

Adolescent↗
PubMed2006

Recurrence related to treatment modalities of unicystic ameloblastoma: a systematic review.

This systematic review aims to identify all studies pertinent to the clinical question, 'which treatment for unicystic ameloblastoma results in the lowest recurrence rate?' A structured systematic search of the literature, with predefined inclusion and exclusion criteria, using computer and manual searches as well as personal communication, was performed. Evaluations and critical appraisal were done separately in 3 rounds. All searches were performed by 2 independent judges and any disagreement was settled by discussion with a third party. Four treatment modalities for unicystic ameloblastomas were identified. The recurrence rates were 3.6% for resection, 30.5% for enucleation alone, 16% for enucleation followed by application of Carnoy's solution and 18% for marsupialization with/without other treatment in a second phase. It was concluded that there is only weak evidence showing that jaw resection resulted in the lowest recurrence rate, followed by enucleation with application of Carnoy's solution. Enucleation alone resulted in the highest recurrence rate and treatment by marsupialization cannot be sufficiently evaluated since most cases were followed by a second stage surgery of some kind.

Acetic Acid↗
PubMed2003

Low-molecular-weight heparin for the long-term treatment of symptomatic venous thromboembolism: meta-analysis of the randomized comparisons with oral anticoagulants.

BACKGROUND: The management of venous thromboembolism (VTE) requires an initial treatment with unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH), followed by oral anticoagulants (OA) for at least 3 months. OA treatment however, requires laboratory monitoring of anticoagulation, carries a definite risk of bleeding, and may be contraindicated in some patients. As an alternative to vitamin K antagonists, subcutaneous LMWH has been proposed and evaluated in randomized clinical trials, but they are all small studies that lack the power to establish if these two treatment modalities are equivalent in efficacy or safety. OBJECTIVES: The objective of this review was to evaluate the efficacy (VTE recurrence) and safety (bleeds and deaths) of long-term treatment of VTE with LMWH compared with OA. A secondary endpoint was to evaluate the effect of LMWH on cancer mortality. METHODS: Computerized searches of MedLine and EmBase were performed. In addition, randomized clinical trials were located through personal communication with colleagues, and through the manual scanning of meeting proceedings and reference lists of relevant studies. When necessary, the authors of the selected papers were called to obtain additional information. Two reviewers (AI and FG) reviewed and extracted data independently using a standard form. The primary analysis was performed for efficacy and safety endpoints on an intention-to-treat basis for the study period of randomized treatment. A meta-regression analysis was used to investigate the relationship between daily dose and clinical outcome. RESULTS: Seven studies that fulfillled our predefined criteria were identified, for a total of 1379 patients. When all studies were combined, a statistically non-significant reduction in the risk of VTE (OR 0.66; 95% confidence interval [CI] 0.41, 1.07) and in the risk of major bleeding (OR 0.45; 95% CI 0.18, 1.11) in favor of LMWH treatment was found. No difference in total mortality (OR 1.19; 95% CI 0.78, 1.83) or in cancer-related mortality was observed between the LMWH and the OA treatment. CONCLUSIONS: The results of this meta-analysis indicate that a 3-month course of LMWH is as effective and safe as a corresponding period of OA treatment, and may thus be considered as a valuable alternative option for patients in whom OA treatment appears contraindicated or problematic.

Anticoagulants↗
PubMed1997

Gap junctional units are functionally expressed before first cleavage in the early ascidian embryo.

Manually apposed ascidian zygotes established electrical communication within 50 min of fertilization and before cytokinesis. Junctional conductance between zygotes was 14.5 +/- 2.9 nS (n = 7), similar to that previously reported for ascidian two-cell-stage blastomeres, suggesting that zygotes and blastomeres express an equivalent number of gap junctional half-channels. Because puromycin at 400 microM does not inhibit the functional expression of these half-channels, they appear to be of maternal origin and their activation does not require protein synthesis. Loading zygotes with 500 mM ethylene glycol-bis(beta-aminoethyl ether)-N,N,N',N'-tetraacetic acid or exposing zygotes to 10 microM of the calcium ionophore A-23187 shows that these half-channels are regulated by intracellular calcium, consistent with the behavior of these channels in adult tissues. The results show that gap junctional units are expressed in the ascidian at the zygote stage.

Animals↗
PubMedDate not supplied

Micromanagement--a costly management style.

Micromanagement can be advantageous in certain short-term situations, such as while training new employees, increasing productivity of underperforming employees, controlling high-risk issues, and when there can be no question of who is in charge. However, the costs associated with long-term micromanagement can be exorbitant. Symptoms such as low employee morale, high staff turnover, reduction of productivity and patient dissatisfaction can be associated with micromanagement. The negative impacts are so intense that it is labeled among the top three reasons employees resign. Ultimately, micromanagement leads to decreased growth potential in a department. Managers who put too much emphasis on daily operational details can miss the broader picture and fail to plan for departmental expansion. Eventually, many micromanagers find themselves at considerable risk of burnout. Changing behavior associated with micromanagement can be a lengthy and difficult process. As with most problems, the first step is to realize that there is behavior that needs to be changed and to understand how it negatively impacts the department. Conducting a self-assessment of one's leadership style can be advantageous in this process. The true task is to find a balance between effectively performing daily obligations and strategically planning for the future. This task typically involves proper delegation of duties, and that in itself is a difficult challenge. Proper delegation of tasks may be the primary key to combating micromanaging behavior, however, some other suggestions include: 1. Develop a vision of what the department will look like in the future. 2. Hire people with the right skills for the job. 3. Develop a policy and procedures manual. 4. Develop solid lines of communication between managers and subordinates. 5. Expect some employee errors. Mistakes are an important process in the learning experience and should be viewed as a training expense. Employees who are allowed to be self-directed will be motivated to be more productive. Staffing issues such as low morale and high turnover will decrease; patient satisfaction will increase simultaneously.

Administrative Personnel↗
PubMed1972

Vocal rehabilitation after partial or total laryngectomy.

One of the paramount concerns of a patient who must undergo surgical intervention for laryngeal cancer is the effect on his speech. The type of operation is based on the anatomic extent of the cancer, but each procedure presents inherent problems in vocal rehabilitation. Glottic incompetence is the primary deficit to be overcome following hemilaryngectomy, whereas the aspirate voice is the principal problem with supraglottic laryngectomy. When the larynx must be sacrificed by total laryngectomy, the patient attempts to learn esophageal speech. If this fails, a vibrating sound source for speech can be acquired, either by the construction of a trachealpharyngeal communication or by use of a manual electric vibrator.

Humans↗
PubMed1994

Recent progress in cancer pain management and palliative care in Japan.

One out of every four deaths in Japan is due to cancer, so that health-care workers and the lay public have gradually become aware of the importance of cancer pain relief and palliative care in recent years. In 1984, the feasibility and effectiveness of the WHO method for relief of cancer pain was demonstrated in Japanese cancer patients. Thereafter, information on the latest knowledge and skills in cancer pain relief and palliative care has been disseminated through medical meetings, publications and mass communication networks. The national government published manuals of care for terminally ill cancer patients and amended narcotics regulation in order to improve the accessibility of opioid analgesics, especially morphine, to cancer patients with pain. These activities resulted in a 35-fold increase in the annual consumption of morphine preparations for medical purposes between 1979 and 1992. However, the annual consumption per capita is still much smaller than that in other developed countries, indicating the need for further information dissemination and professional education in the implementation of palliative care programmes.

Attitude of Health Personnel↗
PubMed1994

Use of immune globulin to prevent symptomatic cytomegalovirus disease in transplant recipients--a meta-analysis.

The objective of this meta-analysis was to review the evidence for the use of immune globulin in the prevention of symptomatic cytomegalovirus (CMV) disease in transplant recipients. A computerized search of Medline from 1980 to October 1991 was conducted using the textword "cytomegalo:" and the subheading "prevention and control" for studies in all languages. Reference lists, a manual search of relevant literature and communication with internationally recognized experts were used to locate additional studies. Of the studies identified, 18 met the inclusion criteria (population: transplant recipients; intervention: immune globulin; outcome: symptomatic cytomegalovirus disease; study design: randomized controlled trial). The meta-analysis of the 18 studies showed a reduction in the incidence of symptomatic CMV disease in the group receiving immune globulin as compared to the untreated group. The common odds ratio was 0.58 (95% C.I. 0.42 to 0.77). Analyses of combining trials by subgroups of polyvalent immune globulin, hyperimmune globulin, bone marrow recipients and solid organ recipients resulted in common odds ratios comparable to the overall common odds ratio. Common odds ratios for the trials reporting cytomegalovirus interstitial pneumonia, cytomegalovirus death, overall death and graft loss ranged from 0.47 to 0.69. Common odds ratios for the effect of immune globulin prophylaxis analyzed by pre-transplant patient/donor cytomegalovirus antibody status ranged from 0.32 to 0.50. In conclusion, the use of immune globulin as passive immunization for the prevention of symptomatic cytomegalovirus disease in the transplant population is supported by this meta-analysis. The response is similar in both bone marrow and solid organ transplant recipients.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytomegalovirus Infections↗
PubMed1998

Mental health problems in primary care. A research agenda.

BACKGROUND: The North American Primary Care Research Group (NAPCRG) Task Force on Mental Health Problems was commissioned to explore critical research and policy issues in mental health and to develop a primary care research agenda for review and action by NAPCRG. This paper presents the key findings and recommendations of the task force. METHODS: As co-chairpersons of the task force, we performed a comprehensive review of the primary care mental health literature using MEDLINE searches with manual follow-up and personal communications with many active researchers in the field. Task force members participated in the editing and refinement of this paper through electronic mail and a series of face-to-face meetings. CONCLUSIONS: Rapid changes in the US health care environment threaten to undo the integration of mental and physical health that is at the heart of primary care. It will be necessary for the primary care leaders in the mental health field to step forward to guide policymakers, purchasers, and the public as primary care is reengineered for the next generation. Efforts to use episode of care and comorbidity recording within electronic medical record systems, particularly in cooperation with managed care corporations or primary care research networks, may represent the most effective strategy for promoting the integration of mental health services into primary care. The most promising area for original research may be the exploration of common mental health problems in the context of routine primary care practice.

Depressive Disorder↗
PubMed1984

Gestural communication in deaf children: the effects and noneffects of parental input on early language development.

We previously reported that deaf children of hearing parents can develop a gestural communication system with some of the observed properties of early child language. In the present study, this phenomenon of gesture creation was replicated in four deaf children aged 1-4 to 3-1 at the time of the first interview. Each child, despite his atypical language-learning conditions (in particular his lack of usable conventional linguistic input, either oral or manual), developed a gesture system comparable in semantic content and structure (specifically, constructional ordering of elements, differential probabilities of production of elements, and recursive concatenation of semantic relations) to the gestural systems of the six deaf children of hearing parents in our original study and comparable as well to the spoken and sign systems of children acquiring conventional languages under typical learning conditions. This phenomenon suggests that the human child has strong biases to communicate in language-like ways. Nevertheless, it is possible that the deaf child's hearing parents, and not the child himself, were responsible for the emergence of the child's structured (yet idiosyncratic) gesture system. To investigate this possibility, we considered three possible parental influences on the child's sentence structures. First, we entertained the hypothesis that the children's sign sentences were merely imitations (perhaps even uncomprehending imitations) of a hearing adult's immediately preceding gestures. Second, we considered the possibility that the regularities underlying the deaf children's structured sign sentences were induced from their hearing parents' gestures taken in toto. Finally, we considered the possibility that the deaf children's sign sentences had been shaped by their parents' responses to those sentences. We found no evidence to support any of these hypotheses. The data reported in this series of studies confirm that deaf children lacking a conventional linguistic input can develop a gestural communication system that shows some of the structural regularities characteristic of early child language. The results suggest that communication with a number of language-like properties can develop in a markedly atypical language-learning environment, even without a tutor's modeling or shaping the structural aspects of the communication. The data are consistent with the hypothesis that the deaf child himself plays a seminal role in the emergence of the structural aspects of these communication systems.

Child, Preschool↗
PubMed2001

An alternative management of older children with persisting communication problems.

Speech and language deficits frequently implicate accompanying psychosocial problems (such as low self-esteem). An alternative management approach is described which adopts a holistic paradigm and provides a unique opportunity for intensive work on communication within a supportive environment. The residential programme for 8-14 year olds with persistent communication difficulties incorporated cognitive, emotional and psychosocial dimensions of communication, co-ordinated with work on speech features. Although the programmes were developed for children with cleft palate, they have potential for benefiting a wide range of communication impairments of different aetiologies. A forthcoming manual with resource material developed by the research team will be used in studies across these groups.

Adolescent↗
PubMed1981

Involving institutional staff in the development and maintenance of sign language skills with profoundly retarded persons.

A program to involve institutional staff in developing manual sign language skills with profoundly retarded persons was evaluated. In Experiment 1, six direct care staff, with close supervision, taught a small repertoire of signs to six profoundly retarded residents who had not benefited from previous training in vocal language. Training was conducted in a group format using instructions, modeling, manual guidance, contingent reinforcers, and feedback. During training, all residents learned to identify pictures of objects with manual signs. Generalization observations during unstructured times on the residents' living unit indicated that staff used their signing skills with the residents in addition to their vocal interactions but the residents did not increase their signing or vocalizing. In Experiment 2, the residents' skills in signing with real objects on their living unit as opposed to pictures of objects were evaluated and provided with additional training where necessary. Results indicated that all participating residents learned to communicate with signing during structured interactions on their living unit, and the skills maintained during follow-up assessments ranging from 39 to 49 weeks. Results are discussed regarding the variable generalization effects noted as well as the general benefits and disadvantages of teaching manual signing skills to profoundly retarded persons.

Adolescent↗
PubMed1986

An evaluation of the relationship between receptive speech skills and expressive signing.

We examined the effects of receptive speech on the acquisition of manual signing among three mentally retarded children. In an alternating treatments design, we compared the acquisition of expressive signs that were, versus were not, in a child's receptive vocabulary. The children were trained via total communication in which pictorial referents were named during sign training. Signs corresponding to known words were generally acquired faster and retained better than signs corresponding to unknown words. We conducted posttests to assess the stimulus control of signing and any changes in expressive and receptive signing and speech. Observed changes in performance could be accounted for by attention to aspects of the stimulus complex during training and functional equivalence of stimuli established by training.

Child↗